Successful treatment of severe infection of the femur originating from pelvic abscess.

A 35-year-old man sustained multiple injuries including a fractured pelvis, a ruptured urethra, and a femur fractured at the neck, the shaft, and the supracondylar region. The fractured femur was grade IIIB open. Urethrography showed a ruptured urethra with extravasation of the dye into the upper thigh. Internal fixation of all femur fractures and the pelvis fracture was successful. A suprapubic cystostomy tube was inserted to manage the urethral tear. The tube became infected, and the infection extended from the pelvis into the thigh region, infecting the femoral fracture. The femur infection was thought to be a postoperative one that had originated locally. Computerized tomography (CT) scan was helpful in localizing the infection and its origin from the pelvis. Treatment included incision and drainage, with aggressive serial débridement of both abscesses. In addition, bone grafting of the femur was performed. The infection was controlled completely, and the patient returned to work 18 months after injury. The authors alert the orthopaedic surgeon to the possibility of this serious lesion, particularly when the initial urethrogram shows extension of the dye below the inguinal ligament.

The perioperative management of protein S deficiency in total hip arthroplasty.

Protein S is an antithrombotic plasma protein that serves as a cofactor for another plasma protein, activated protein C. Patients who express a deficiency of protein S have an increased propensity to experience thromboembolic events. These events are often precipitated by factors that may cause thrombosis in nondeficient individuals, particularly in cases of trauma, pregnancy, or surgery. Anticoagulation therapy was instituted in a 45-year-old woman with known protein S deficiency and bilateral total hip arthroplasties.

Fracture-dislocation of the ankle with fixed displacement of the fibula behind the tibia.

Fracture-dislocation of the ankle with fixed displacement of the fibula behind the tibia (Bosworth fracture-dislocation) is infrequently encountered in clinical practice. The diagnosis of this entity is often overlooked due to an inability to correlate clinical findings with roentgenographic data. The mismanagement that follows an incorrect diagnosis may render a patient permanently disabled. The authors report a case of Bosworth fracture-dislocation and describe the steps leading to proper diagnosis and treatment of this rare injury.

Comparison of perioperative morbidity of anterior cruciate ligament autografts versus allografts.

We present a retrospective report of 50 patients (31 autograft and 19 allograft patients) who underwent arthroscopic bone-patellar tendon-bone anterior cruciate ligament (ACL) reconstructions between August 1988 and September 1990. All patients were followed for a minimum of 2 years. The purpose of this study was to analyze each group regarding hospital stay, swelling, thigh atrophy, laxity, strength, endurance, range of motion, patellofemoral symptoms, and complications. We found no statistical difference between autograft or allograft ACL reconstructions with regard to perioperative morbidity.

A calcified ligamentum teres mimicking entrapped intraarticular bony fragments in a patient with acetabular fracture.

A motor vehicle accident victim presented with a fractured acetabulum and had apparent entrapped bony intraarticular fragments seen on computed tomography scanning. At surgery, these fragments were found to be a partially avulsed calcified ligamentum teres that was apparently caused by a previous injury of the same hip. Excision of the calcified ligament and surgical stabilization of the acetabulum were performed. A calcified ligamentum teres may be confused with entrapped bony fragments and therefore cause difficulty in the evaluation and management of acetabular fractures.

Simultaneous bilateral intraocular surgery.

During the past ten years, the frequency of bilateral simultaneous intraocular surgery has increased and the majority have been cataract extractions. Two hundred and fifty-one patients have had this operation. The pre- and postoperative acuities and the complications have been tabled and the assessment indicates that this is a safe and successful approach considering the age of the patients and the associated pathology. There was no bilateral operative disaster. Of 232 patients whose post-operative acuities were recorded and are known, no patient had worse binocular acuity following bilateral simultaneous cataract extraction. Hospital time in the clinics, the ward and the operating theatre has been saved and the patients are more quickly returned to balanced binocular vision.

Evaluation of vision in slow-stream wards.

Two hundred and twenty-one patients in slow-stream geriatric wards in the Portsmouth district were questioned about their vision; 159 of these were examined. It was possible to give help with vision to 21 per cent of patients and to give a further 6 percent help with other eye problems. Eighteen months later, when half the patients examined had died, 14 per cent of those still alive were continuing to enjoy their improved vision, and 6 per cent were benefitting from the help they had received with other eye problems. As a result, we recommend that all admissions should be assessed with regard to their visual ability and that all those with adequate mental faculties should be examined by an ophthalmologist or an optician on admission and when necessary therafter.